Oxidized Cellulose (Surgicel) As a Surgical Hemostat in Liver Injury: A Case Report and Litrature Review

Liver is a common solid organ inju red in a blunt abdominal injury; frequently inflicted by motor vehicle accidents (MVA). Whilst most low grade liver injury is managed conservatively, operative approach remains an option in many cases, notably liver packing. A 15 year-old Malay, male who sustained a blunt abdominal inju ry and fractured left clavicle with no loss of consciousness was referred to a tertiary level hospital, six hours fo llowing an MVA. On arrival, patient appeared restless; blood pressure was 90/50 mmHg, d istended abdomen with board-like rigid ity in both upper quadrants and was managed for hypovolaemic shock. His haemoglobin was 4g/dl. Subsequent imaging revealed a fluid collection in the Morrison’s pouch on ultrasound while computed tomography (CT) scan revealed grade IV splenic injury and 5 & 6cm lacerat ions in segment II & VII o f the liver respectively. The operative findings were shattered spleen (grade V injury), a concealed liver laceration and a massive clot at the splenic bed. Splenectomy was done along with oxidized cellu lose (surgicel) packing of the liver. The estimated blood loss was 4 litters. The post-operative recovery over six weeks was uneventful and was vaccinated against encapsulated organisms prior to d ischarge. Grade IV liver injury using oxidized cellu lose (Surgicel) p roven to good response.